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Potomac Baptist Association Encouraging, strengthening and assisting member churches
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PBA
CHURCHES |
Please print out this frame or the Word document linked here and send your information to: Potomac Baptist Association
Hughesville, MD 20637 ATTENTION: MEXICO '08 YOU CAN FAX THE FORM TO: 301-274-5119
APPLICATION PBA MEXICO MISSION TRIP July 11-18 and/or August 2-9, 2008 Please circle your dates of choice.
Name as appears on Social Security Card or Passport: First ________________ Middle____________ Last_____________________ Male_______ Female_______ Married_______ Single_____ Birthdate: Month_______ Day _______ Year_______ Street Address______________________________________________________ City ________________ State__________ Zip __________ Home Phone_______________ Office Phone________________ Email Address_____________________ Cell Phone_____________________ PBA Church Membership________________________ Fluency in Spanish __________ List any other Mission Trips or mission experiences you have had: __________________________________________________________________ __________________________________________________________________ Medical Conditions__________________ Allergies_______________________ Pastor’s Approval/Signature__________________________________________
Details of the trip are available from the PBA |
